It was 2010, a few years after we started the first independent health advocacy company in Washington state, Allied Health Advocates, when the phone rang with a story I will never forget. Ted wanted to hire a health advocate for his wife who had been in the hospital for a year, in a coma for at least part of the time. He had just heard that the hospital wanted to pull all of her teeth. What was remarkable was that prior to going into the hospital, she had just had all of her teeth re-capped and they were in perfect condition. Ted told me that when he had asked the hospital if they had seen issues when they brushed her teeth, the hospital replied that they had not brushed her teeth – ever. This was a memorable story for me.
This story made me wonder how something so basic, so essential to self-care, could be overlooked. Although I never spoke with the hospital, it was a powerful image that stuck with me.
Seven years later, my good friend Deborah’s husband, Reid, was in the hospital to address nutrition and pain issues related to his prostate cancer. Reid was a quiet, tall (over 6 feet) long-time engineer for Boeing, with a gentle, kind spirit and loved taking landscape photos. Although I didn’t know Reid well, I always admired his positive attitude and his ready-for-anything relationship with Deborah. He always focused on what was going well.
I visited Reid in the hospital before his meeting with an attorney who would arrive later in the day. It was to be the main effort for his day, as Reid was growing increasingly weak. I asked him how he wanted to prepare for his meeting with the attorney. After giving it some thought, he said he would like to shave and be dressed in his clothes instead of the hospital gown. By this point, he had been in the hospital for four days. Although a typical hospital stay would include a shower every couple of days, I learned that sometimes that doesn’t happen unless someone asks. Although he could walk with help and was awake much of his hospital stay, he was fairly weak, but still had a very strong spirit. Reid was too weak to shower or shave on his own. He could lift a spoon to his mouth with significant effort. I asked about whether he had brushed his teeth and he quietly said “no.” I asked if he would like his teeth brushed. Although he couldn’t speak clearly, he nodded his head vigorously. It had been four days since someone brushed his teeth.
When asked, the nurse took care of brushing his teeth right away, giving Reid the dignity and confidence he deserved. It was a little but important thing. But you had to know to ask.
WHY IT MATTERS:
Preventative oral care lowers overall costs in the long run, so take care of your teeth before it is an issue.
Lack of oral care in the hospital can lead to other health issues, such as pneumonia if a person is on a ventilator.6 In fact, being on a ventilator is a key risk factor in hospital-acquired pneumonia. One study found that increased assessment, cleaning, and suctioning of non-ventilator patients reduced hospital acquired pneumonia by 37%.
After staying in the hospital for a day or two, bacteria in your mouth become more like the hospital environment. Bacteria replicates so quickly in your mouth that it can take only a matter of hours to cause problems.
USING THIS INFORMATION:
When hospitalized, ask the nursing staff how they handle oral health, including teeth brushing. How will they handle your loved one’s mouth care?
Be prepared to help if needed.
Certain diseases and treatments can cause sores in the mouth, which might require mouth rinses or swabbing instead of teeth brushing. Sometimes patients may have trouble swallowing.
When a patient is on a ventilator, it is particularly important that mouth rinses or swabbing are used to cleanse the mouth.
SPECIFIC LANGUAGE YOU CAN USE:
I am wondering how the hospital typically handles oral health for patients.
Could you share with us how the nursing staff intends to handle oral health with our case?
What can I do to help with oral care while we are here
ADDITIONAL READING AND RESOURCES:
To find a free or low-cost sliding scale dental clinic in your area: http://www.needymeds.org/dental-clinics
The Joint Commission urges enforcement of oral care policies: https://www.hcpro.com/ACC-328832-4634/Joint-Commission-urges-enforcement-of-oral-care-policies.html
Teeth, by Mary Otto: A book showing how oral health influences all aspects of our lives: https://www.amazon.com/Teeth-Beauty-Inequality-Struggle-America/dp/1620971445
ABOUT THE CONTRIBUTOR:
Deborah Wakefield has shared her husband, Reid’s, story and it is used with permission.